Sunday, September 6, 2009

A Sense Of Entitlement

Dr. Donald F. Condon wrote an opinion piece which was printed in yesterday's Spokesman Review. He leads off with this:

"The primary problem with Medicare is simply this: Medicare doesn’t pay. Reimbursement for care is 35 to 50 cents on the dollar of charges submitted. This doesn’t cover overhead. It costs more to provide care for a Medicare patient than the reimbursement schedule pays.

Medicare payments represent 5 percent of my income, so that means 25 percent of my day I am working for free. This busyness does not mean business is good. My practice population is aging and matriculating into Medicare coverage, threatening the viability of my practice."

He then continues on stating how bad Medicare is and supporting each declaration with what sounds like weak, selective support.

"Medicare is irresponsible and not held accountable: About two years ago Medicare prematurely launched a new computer program that was not ready to handle its own billing requirements. The consequence to my practice was that over $60,000 in charges was not paid for over six months."

Having been on both ends of the "computer program" spectrum--development and implementation--for 20 years, I have never seen a new "computer program" go in flawlessly.

Medicare interferes with the doctor-patient relationship: Medicare instructs patients to report physicians they feel may be overbilling. This is an unfair burden on the patient.

I'm sorry, but I just can't wrap my brain around that. If you tell a patient to report when a doctor is cheating the system you are interfering with their doctor-patient relationship? Do you mean the part where they're supposed to trust their doctor?

"I know of no other industry that is as mistreated as the health care industry. Government and military contract winners expect a profit, sometimes even large profits. Only the health care industry, charged with the health of the nation, is expected to subsidize the government."

So it's all about the money? Well, maybe not.

"Most of the physicians I know are generous and serving; that is why they are in health care."

What a wonderful sentiment. But at the beginning he said,

"I have worked with Medicare for 30 years, feeling I was doing my part. If ever there was such an obligation, it was paid back years ago."

So it must be all about the money.

"The Medicare system has taken advantage of the generosity of the physician for far too long. The current administration claims that physicians are paid too much and proposes to pay even less."

Is it unreasonable for him to expect what he thinks he is owed since he has obviously paid his dues?

Not at all. But the majority of his piece does not address that. Consequently, the tenor of his letter leans towards a rant.

Rather than making use of the available space to present a cogent argument about the "primary problem" (as he called it) that Medicare doesn't pay, the good doctor goes off on tangents to denigrate Medicare. This does nothing more than appeal to people who already agree with him. It diverts attention from--and adds nothing to--the argument he's trying to make.

And this statement is particularly telling of his sense of entitlement.

I have worked with Medicare for 30 years, feeling I was doing my part. If ever there was such an obligation, it was paid back years ago.

Addendum: According to the claim summaries for my emergency room visit to stitch up my box cutter wound, the hospital billed $1188 and TriCare allowed $415. $30 of that is my co-payment. The reimbursement rate is 35% of the billed amount.

Paying less than the billed amount is not unique to TriCare or Medicare. Nor it is a recent problem. See http://community.seattletimes.nwsource.com/archive/?date=20040330&slug=premera30m. This was an issue again just a year ago. See http://www.spokesmanreview.com/breaking/story.asp?ID=16733 and scroll down where it's mentioned.

I am ex-military and also have TriCare for my medical as well as Delta Dental. Over the past couple of years I have had to find new dentists as my current dentist, at that time, stopped accepting Delta Dental. And while finding a replacement was not overwhelmingly difficult, it did require a number of calls until I was able to successfully locate a provider who would accept my dental plan.

And while I have no way of knowing, I suppose the numbers of providers who accept TriCare could be shrinking a bit a well.

We may see more of this in the future depending on percentages of provider payouts.

This whole thing isn't unique to Medicare. I had to take a trip to the emergency room not long ago and then get some imaging done as a follow-up and the insurance reimbursement was considerably less than the "retail" cost of treatment. I have private insurance. I would guess that one of the reasons that the nominal cost of healthcare has been rising is that providers are raising their "retail" prices so that their discounted reimbursements come closer to the actual cost. The sad thing of it is that the uninsured end up getting stuck with the retail cost, since they don't have an insurer to negotiate discounts.

The other thing is that no one forces the provider to accept Medicare, or insurance for that matter. They have the option to work for cash, but know that so few people are willing or able to operate that way that there isn't an easily sustainable model for doing so. In the end, I want doctors who practice medicine out of a deeply rooted need to serve others. I know medical education is expensive, and that the years out of the workforce while in school put doctors behind the curve in terms of saving for retirement. Those are things we can fix, and should fix.

I agree that the Dr.'s point was kind of ranty, and didn't do anything to advance the discussion.